close

Вход

Забыли?

вход по аккаунту

?

s12671-017-0841-8

код для вставкиСкачать
Mindfulness
https://doi.org/10.1007/s12671-017-0841-8
REVIEW
A Systematic Review and Meta-analysis of the Effects
of Meditation on Empathy, Compassion, and Prosocial
Behaviors
Christina M. Luberto 1,2 & Nina Shinday 3 & Rhayun Song 4 & Lisa L. Philpotts 5 &
Elyse R. Park 1,2 & Gregory L. Fricchione 1,2 & Gloria Y. Yeh 3
# Springer Science+Business Media, LLC 2017
Abstract Increased attention has focused on methods to increase empathy, compassion, and prosocial behavior.
Meditation practices have traditionally been used to cultivate
prosocial outcomes, and recently investigations have sought
to evaluate their efficacy for these outcomes. We conducted a
systematic review and meta-analysis of meditation for
prosocial emotions and behavior. A literature search was conducted in PubMed, MEDLINE, PsycINFO, CINAHL,
Embase, and Cochrane databases (inception to April 2016)
using the following search terms: mindfulness, meditation,
mind-body therapies, tai chi, yoga, MBSR, MBCT, empathy,
compassion, love, altruism, sympathy, or kindness.
Randomized controlled trials in any population were included
(26 studies with 1714 subjects). Most were conducted among
healthy adults (n = 11) using compassion or loving kindness
meditation (n = 18) over 8–12 weeks (n = 12) in a group
format (n = 17). Most control groups were wait-list or no
treatment (n = 15). Outcome measures included self-reported
emotions (e.g., composite scores, validated measures) and
* Christina M. Luberto
[email protected]
1
Department of Psychiatry, Harvard Medical School/Massachusetts
General Hospital, 15 Parkman Street, Boston, MA 02114, USA
2
Benson-Henry Institute for Mind-Body Medicine, Massachusetts
General Hospital, 151 Merrimac St, Boston, MA 02114, USA
3
Division of General Medicine and Primary Care, Harvard Medical
School/Beth Israel Deaconess Medical Center, 1309 Brookline
Avenue, Boston, MA 02445, USA
4
Chungnam National University, 6 Munwha 1-Dong, Jung-Gu,
Daejeon 301-747, South Korea
5
Treadwell Library, Massachusetts General Hospital, 125 Nashua
Street, Boston, MA 02114, USA
observed behavioral outcomes (e.g., helping behavior in
real-world and simulated settings). Many studies showed a
low risk of bias. Results demonstrated small to medium effects
of meditation on self-reported (SMD = .40, p < .001) and
observable outcomes (SMD = .45, p < .001) and suggest psychosocial and neurophysiological mechanisms of action.
Subgroup analyses also supported small to medium effects
of meditation even when compared to active control groups.
Clinicians and meditation teachers should be aware that meditation can improve positive prosocial emotions and
behaviors.
Keywords Meditation . Mindfulness . Empathy .
Compassion . Prosocial
Introduction
There has been a recent increase in research focused on empathy, compassion, and prosocial behaviors (Kirby 2017;
Strauss et al. 2016). Although there are varying definitions
of empathy and compassion, they are often considered related
but distinct prosocial emotions that consist of cognitive and
affective components and can be learned with practice
(Bibeau et al. 2016; Goetz et al. 2010). Empathy involves
vicariously experiencing another’s emotions by recognizing,
understanding, and resonating with their emotional state
(Bputting yourself in someone else’s shoes^; Hogan 1969;
Lazarus 1991; Strauss et al. 2016). Compassion takes empathy
a step further and involves not only emotional recognition,
understanding, and resonation but also the ability to tolerate
one’s own emotional reaction and the motivation to act to
relieve the others’ suffering (Bsuffering with^; Gilbert 2010;
Strauss et al. 2016). Actions taken with altruistic intentions to
help or benefit another person are broadly considered
Mindfulness
prosocial behaviors (e.g., volunteerism, charitable donation,
care-taking; Penner et al. 2005). Research supports the idea
that greater empathy leads to greater compassion, and greater
compassion leads to greater prosocial behavior (Lim and
DeSteno 2016).
Prosocial emotions and behaviors are important for both
individual and societal well-being. Empathy and compassion
are emphasized across diverse social institutions, including
healthcare, education, and justice systems, as well as most
world religions (Faulkner and McCurdy 2000; Goetz et al.
2010). They are thought to confer adaptive evolutionary value
by guiding individuals to protect and care for their offspring,
family, as well as other community members, thereby maximizing the likelihood of survival and genetic propagation
(Goetz et al. 2010). Prosocial outcomes have a positive public
health impact because they not only benefit the individual
receiving help, but they also benefit the helper. Indeed, a large
body of research demonstrates that engaging in prosocial behavior is associated with greater happiness and psychological
well-being, indices of physiological health (e.g., increased
heart rate variability, immune function, telomere length, genetic expression), better physical functioning, better interpersonal relationships, and decreased morbidity in medical populations (Dunn et al. 2008; Hoge et al. 2013; Ironson 2007;
Nelson et al. 2016; Pace et al. 2009; Weinstein and Ryan
2010). These benefits are greater for prosocial behavior as
compared to self-focused helping behavior (e.g., Nelson
et al. 2016). Given the wide range of social problems currently
harming individuals and societies worldwide, the need for
greater empathy, compassion, and prosocial behavior is clear
(Hurst et al. 2016; Pascoe and Richman 2009).
Meditation is one way to increase an individual’s empathy,
compassion, and prosocial behavior. Meditation encompasses
a collection of mental training practices that involve selfregulating one’s attention toward a chosen object of awareness
from one moment to the next; it can take various different
forms depending on how and where attention is focused
(Kabat-Zinn 1982; Walsh and Shapiro 2006). Meditation
practices have been used for centuries across a range of contemplative communities and historically emphasized as
methods to reduce suffering for the self and others within a
moral or religious context of benevolence and nonharming
(Goldstein and Kornfield 2001; Nydahl 2008; Sears et al.
2011). Over the past twenty years, meditation practices have
been increasingly secularized and integrated into psychological interventions to improve both negative and positive emotional outcomes (Kirby 2017).
Two meditation practices that have received particular attention are mindfulness meditation and loving kindness meditation (LKM) practices derived from Buddhist contemplative
traditions. Mindfulness meditation involves self-regulating
one’s attention to intentionally notice present moment experiences openly and nonjudgmentally as they occur (Sears et al.
2011). It incorporates the related practice of concentration
meditation in that it involves focused concentration on an
object of experience in the present moment. LKM is a more
directly prosocial meditative practice aimed at increasing four
specific other-oriented positive attitudes: loving kindness,
compassion, empathic joy, and equanimity. LKM practices
involve intentionally cultivating awareness of feelings of
warmth, kindness, and compassion for others through mental
visualizations, mantras, and/or other aspirational phrases
(Wallace 1999). There are also compassion meditation practices, which can be similar to LKM practices but have a
unique focus on imagining another’s suffering and relieving
that person’s suffering (e.g., by extending a heartfelt wish or
imagining a golden beam of light toward them). Movementbased meditation practices derived from disciplines such as
yoga and tai chi, which combine mindfulness meditation with
physical postures or exercises, have also received increased
research attention (Luberto et al. 2013).
There is a strong evidence base to support the efficacy of
meditation-based interventions for improving emotional outcomes. This research work had initially been focused on decreasing negative emotions (i.e., rather than increasing positive emotions) using mindfulness-based interventions such as
mindfulness-based stress reduction (MBSR; Kabat-Zinn
1982) and mindfulness-based cognitive therapy (MBCT;
Segal et al. 2012). The results of several systematic reviews
and meta-analyses of mindfulness-based interventions suggest
that these treatments significantly improve stress, anxiety, depression, quality of life, and emotion regulation across a range
of psychiatric and medical populations (Bohlmeijer et al.
2010; Eberth and Sedlmeier 2012; Gotink et al. 2015;
Hofmann et al. 2010; Khoury et al. 2013; Piet et al. 2012).
Reviews of movement-based mindfulness practices also show
promising results for improving emotional problems (e.g.,
anxiety, depression), though these results are more preliminary given the limited methodological quality of these studies
to date (Kirkwood et al. 2005; Luberto et al. 2013; Uebelacker
et al. 2010).
More recently, research has begun to focus on LKM practices to decrease negative and promote positive emotions.
Hofmann et al. (2010) suggested that LKM practices may be
integrated into cognitive-behavioral therapies to improve
emotions and behaviors related to interpersonal relationships,
and a recent meta-analysis found that LKM indeed improves
depression, mindfulness, compassion, self-compassion, and
positive affect (Galante et al. 2014). Other meta-analyses of
LKM for improving self-oriented positive emotions (Zeng
et al. 2015) and general psychosocial outcomes (Shonin
et al. 2015) have shown significant benefits. A narrative review also suggested that compassion meditation promotes
prosocial outcomes in psychotherapists (Bibeau et al. 2016).
Despite the multiple reports of meditation and emotional
well-being, no research has systematically reviewed the
Mindfulness
results of meditation interventions for prosocial outcomes.
Previous systematic reviews and meta-analyses have tended
to focus on one specific type of meditation practice (e.g.,
mindfulness or LKM; Galante et al. 2014; Zeng et al. 2015),
negative emotions (Hofmann et al. 2010), or self-focused positive emotions (e.g., Zeng et al. 2015). Those that did incorporate empathy and compassion outcomes either did not specifically include prosocial search terms (Galante et al. 2014;
Shonin et al. 2015) or were not systematic and only examined
outcomes in one specific population (i.e., psychotherapists;
Bibeau et al. 2016). Thus, a comprehensive and systematic
review of meditation for prosocial outcomes is lacking.
The purpose of the current study is therefore to conduct a
systematic review and meta-analysis of randomized controlled
trials of meditation-based clinical interventions for improving
prosocial emotions and behaviors. Specifically, the aims are to
synthesize existing results regarding effects and potential
mechanisms of meditation for prosocial outcomes, estimate
the effect size of meditation on prosocial outcomes, assess
the quality of trials conducted, identify directions for future
research, and draw evidence-based conclusions to guide future research and clinical practice.
controlled trials for systematic reviews (Royle and Waugh
2005). An additional filter was used to limit to English language studies. No publication date limits were used. See
Appendix for the full search strategy in Ovid Medline.
Eligibility Criteria
Randomized controlled trials of a meditation-based intervention that assessed at least one quantitative outcome related to
prosocial emotions or behaviors were eligible for inclusion.
Meditation-based interventions were considered those whose
theoretical foundation incorporated philosophies from meditative traditions and provided direct and consistent training in
meditation practices as the primary foundation of the intervention (i.e., across at least half of the sessions). Studies that only
assessed self-focused compassion were excluded.
Unpublished manuscripts, conference presentations, and dissertations were excluded. Non-English studies were excluded
due to insufficient funds for translation. We did not exclude
studies based on patient demographics such as age or clinical
status (i.e., studies of children and adults of any population
were included).
Data Extraction and Synthesis
Method
Literature Search
A literature search was performed by a medical librarian (LP)
in the Ovid Medline, PubMed, Ovid PsycINFO, CINAHL,
Embase, Cochrane Library, and ClinicalTrials.gov databases
from inception through April 2016. Similar to previous
reviews of meditation (Gotink et al. 2015), search terms were
intended to capture studies of meditation interventions that
have been secularized for delivery in standard clinical practice
settings. We only included secular practices because these are
more likely to be offered in standard clinical practice settings
(e.g., MBCT, MBSR), they can promote a wider outreach for
individuals who may not subscribe or feel comfortable with
nonsecular practices, and much of the literature to date has
tended to focus on secularized interventions. Nonsecular practices are also often religion-specific and may not be generalizable. Prayer was excluded as it is inherently nonsecular.
Also similar to previous reviews, cognitive-behavioral therapies (CBT) that do not use formal meditation practice consistently as the foundation of treatment were excluded (e.g.,
traditional CBT, dialectical behavior therapy, acceptance and
commitment therapy; Hofmann et al. 2010). Thus, search
terms included the following: meditation, mindfulness,
MBSR, MBCT, mind-body therapies, tai chi, yoga, empathy,
compassion, sympathy, love, altruism, and kindness. Each
search query was combined with a filter based on Royle and
Waugh’s search strategy for identifying randomized
Two independent reviewers (CML and NS) extracted data
from each study and discussed results to ensure agreement.
Any discrepancies were resolved through discussion with the
senior author (GY). The following data were extracted: study
sample, intervention type and format, control group type and
format, intervention dose and adherence, prosocial outcome
variables and time points, and results for effects on prosocial
outcomes. We also extracted any reported data on potential
mechanisms of meditation effects (e.g., mediation or correlation analyses examining relationships between changes in
prosocial outcomes and other biopsychosocial variables).
Risk of Bias Assessment
Two independent reviewers (CML and NS) assessed risk of
bias for each included study according to Cochrane
Collaboration guidelines (Higgins and Green 2008). Risk of
bias was assessed as high, low, or unclear for each of the eight
domains: random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessors, incomplete data, selective reporting, baseline
imbalance, and differential attrition (Jüni et al. 2001; Liberati
et al. 2009). In our synthesis, particular attention was paid to
low-risk studies, defined as studies with low risk on most (5
out of 8) of the domains assessed. Studies that were not
deemed low risk and showed a high risk of bias on only one
domain or had an unclear risk of bias on at least half of the
domains (4 out of 8) were considered medium risk. Studies
Mindfulness
with high risk of bias on more than one domain were considered high risk.
Meta-analysis
Using the program Comprehensive Meta-Analysis (Version
3.0; Borenstein et al. 2014), we conducted a meta-analysis
on subjective and objective outcomes among studies that provided sufficient data for meta-analysis. One reviewer (CML)
extracted data for meta-analysis and a second independent
reviewer (RS) verified the results, with no discrepancies noted. Data were extracted for mean and standard deviation (SD)
of the pretest and posttest values, mean and SD of change
scores and sample size for each group, and t score or p value
within groups. A pooled effect size was calculated for subjective and objective outcomes separately. Since the outcome
variables were measured in different scales, the standardized
mean difference (SMD) was used as an estimate of effect size.
Subgroup analyses were also conducted to calculate effect
sizes for meditation when compared to active controls versus
inactive controls. For studies that included two control groups,
we conducted two comparisons and divided the total N by 2 to
avoid overestimation of the study. Given that very few studies
included follow-up data, we focused the meta-analysis on immediate pre-post effects. We examined heterogeneity of the
included studies based on the i-squared statistic and Q test to
determine a fixed or random effects meta-analysis model according to the results (i-squared < 40% for fixed effects;
Higgins and Green 2008). Publication bias was also assessed
by funnel plot and the fail-safe N. We did not contact the
authors to obtain missing data in order to prevent bias introduced by selective responding of authors.
Results
Literature Search
See Fig. 1 for details of our literature search and article selection process according to PRISMA guidelines (Moher et al.
2009). Our search yielded 479 results. After excluding duplicates (n = 282), unpublished manuscripts (n = 18), non-RCTs
(n = 52), non-meditation interventions (n = 18), and studies
that did not quantitatively measure prosocial outcomes
(n = 43) or only measured self-focused compassion (n = 40),
there were 26 studies that met our eligibility criteria.
Characteristics of Included Studies
Table 1 presents a summary of sample characteristics, meditation interventions, control interventions, and outcome measures across the 26 included studies (total N = 1714). Most
studies (n = 22) were conducted in nonclinical adult
Fig. 1 Flowchart of article selection process
populations using a primarily LKM or CM intervention
(n = 10) or both mindfulness and LKM combined (n = 8).
Studies did not tend to use protocolized interventions but rather incorporated similar elements to develop original protocols.
Outcomes included various subjective and objective measures
of empathy, compassion, and prosocial behaviors. All studies
measured outcomes shortly after the end of the intervention;
only four studies incorporated a longer-term follow-up
(range = 8–52 weeks postintervention).
Risk of Bias Assessment
Eleven studies showed a low risk of bias, 12 showed a medium risk, and 3 showed high risk (Tables 1 and 2). Four studies
were classified as medium risk because risk was unclear on
most domains, rather than because there were any high-risk
domains. In general, studies showed lower risk of bias in
terms of selective reporting of outcome measures (24 low
risk), but higher risk of bias in terms of baseline imbalance
(4 high risk), participant blinding, incomplete outcome data,
and differential attrition (3 high risk each; see Fig. 2).
Synthesis of Results for Observable Outcomes
Table 3 presents the summary and results of each study. Most
studies (11 out of 14; 79%) found support for improvements in
observable outcomes following meditation as compared to the
control intervention, with no clear difference in results by study
quality. There were seven low-risk studies that measured observable prosocial outcomes and all of them reported improvements
following meditation (Kang et al. 2014; Kemeny et al. 2012;
Mascaro et al. 2013, 2015; Rosenberg et al. 2015; SchonertReichl et al. 2015; Weng et al. 2013). The majority of these
studies used active control groups (n = 5; Kang et al. 2014;
Mascaro et al. 2013; Schonert-Reichl et al. 2015; Weng et al.
Mindfulness
Table 1
Summary of characteristics of included studies
Sample
Total N (mean; range)
Gender, mean percent
Race, mean percent
Adult studies
Age, M (SD), range
Nonclinical community samples, N
College students, N
Other, N
Child studies
Age, M (SD), range
Conducted in a school setting, N
Meditation experience, N
None
Experienced meditators
Did not specify
Meditation intervention
Meditation type, N
LKM or CM
Combined mindfulness and LKM or
CM
Mindfulness compared to LKM or CM
Primarily mindfulness
Other or did not specify
Intervention format, N
Group format
Individual format (audio recordings)
Both or not specified
Intervention duration, N
8–12 weeks
4–6 weeks
Other or not reported
Recommended at-home practice, N
Control group
Wait-list or no-intervention, N
Active control groups, N
Both active and inactive, N
Type of active controls, N
Education
Cognitive tasks (e.g., cognitive
reappraisal)
Group discussion
Outcome measures
Subjective/self-reported, N
Objective/observable, N
Both subjective and objective, N
Validated self-report measures, N
Type of objective measure, N
Nonconscious or automatic responding
Computerized donation tasks
Real-time helping behavior
Peer-rated prosociality
1714 (66; 29–125)
69%
68%
22
30.58 (10.33),
19–48 years
11
5
6
4
6.28 (3.45), 4–10 years
4
14
3
9
10
8 (2 of these included
yoga)
2
2
4
17
5
4
13
5
8
8 (typically 20 min/day)
15
5
6
5
4
2
12
7
7
15
6
3
3
3
26 studies were included. Gender and race are based on n = 13 studies
because the other 13 did not report these demographics. Type of objective
outcomes sum higher than 14 because one study used two types of objective outcomes
2013, 2015). The remaining seven studies were medium risk,
and four of these found support for improvements in observable
prosocial outcomes as compared to active (Hutcherson et al.
2008; Logie and Frewen 2015) and wait-list controls (Condon
et al. 2013; Flook et al. 2015). Two of the three studies that did
not find significant effects were conducted in children
(Poehlmann-Tynan et al. 2016; Velásquez et al. 2015). Two studies that reported observable improvements were the same studies
that did not find support for subjective improvements (Kang et al.
2014; Rosenberg et al. 2015). Both of the studies that directly
compared mindfulness and compassion meditation found no significant differences between them for improving prosocial outcomes (Condon et al. 2013; Logie and Frewen 2015). In studies
with follow-up assessments, one found maintained gains at
5 months postintervention (Kemeny et al. 2012), and the other
found no significant improvements postintervention or at followup (Poehlmann-Tynan et al. 2016).
A total of 11 studies provided sufficient data on observable
outcomes for meta-analysis with 12 comparisons available
(see Fig. 3). There was sufficient homogeneity among studies
to conduct a fixed effects analysis (i-squared = .00; Q value = 1.82, p = .96). The effect size across these studies was
.45 (p < .001; 95% CI = .28–.61). Results were similar for
studies with active (SMD = .48, p < .001; 95% CI = .25–.72)
and inactive control groups (SMD = .41, p < .001; 95%
CI = .19–.63). Publication bias was not suspected based on
the funnel plot (see Fig. 4) and the number of negative studies
needed to make the results nonsignificant (N = 76, p = .92).
Synthesis of Results for Self-Reported Outcomes
The majority of studies (14 out of 19; 74%) found significant
improvements in self-reported outcomes following meditation
compared to the control intervention for at least one prosocial
outcome (e.g., empathy, compassion, or prosocial behavior).
These results did not appear to appreciably vary depending on
the study’s level of risk of bias. There were seven low-risk
studies and four found support for improvements in selfreported empathy or compassion as compared to wait-list
(Jazaieri et al. 2013; Shapiro et al. 2010) and active control
groups (Kang et al. 2015; Schonert-Reichl et al. 2015). Three
low-risk studies did not find support for subjective improvements (Kang et al. 2014; Keefe 1979; Rosenberg et al. 2015).
There were nine medium-risk studies and eight found support
for subjective improvements (Ashar et al. 2016; Asuero et al.
2014; He et al. 2015; Hutcherson et al. 2008; Logie and Frewen
2015; Oman et al. 2010; Shapiro et al. 1998; Taylor et al. 2015).
Three studies were classified as high risk and two of these
found improvements (Kok et al. 2013; Wallmark et al. 2013).
Both studies that included a long-term follow-up found that
improvements were maintained over time (Oman et al. 2010;
Shapiro et al. 2010).
A total of 18 studies provided sufficient data on self-reported
outcomes for meta-analysis. These studies allowed for 19 comparisons because one study used two control groups. Results
indicated sufficient homogeneity to conduct a fixed effects
meta-analysis (i-squared = .00; Q value = 3.94, p = .49). The
Mindfulness
Table 2
Risk of bias for each study
Allocation
Blinding of
concealment participants and
personnel
Blinding of
outcome
assessors
Incomplete
outcome data
Selective
reporting
Baseline
Differential
imbalance attrition
Ashar et al. (2016) Low
Unclear
Low
Unclear
Low
Low
Unclear
High
Asuero et al.
Unclear
(2014)
Condon et al.
Unclear
(2013)
Flook et al. (2015) Unclear
Unclear
Unclear
Unclear
Unclear
Low
Low
Low
Unclear
Low
Low
Unclear
Low
Unclear
Unclear
Unclear
Unclear
High
Unclear
Low
Low
Low
He et al. (2015)
Hutcherson et al.
(2008)
Jazaieri et al.
(2013)
Kang et al. (2014)
Kang et al. (2015)
Low
Unclear
Unclear
Unclear
Unclear
Low
Unclear
Unclear
High
Unclear
Low
Low
Low
Unclear
Unclear
Low
Low
Unclear
High
Unclear
Low
Low
Low
Low
Unclear
Unclear
Unclear
Unclear
Low
Low
Unclear
Unclear
Low
Low
Low
Low
Low
Low
Low
Low
Keefe (1979)
Kemeny et al.
(2012)
Kok et al. (2013)
Low
Low
Unclear
Unclear
Low
Low
Unclear
Low
Low
Low
Low
Low
Low
Low
Low
Low
Unclear
Unclear
High
Unclear
Low
Low
Low
High
Logie and Frewen
(2015)
Mascaro et al.
(2013)
Oman et al. (2010)
Pearl and Carlozzi
(1994)
Poehlmann-Tynan
et al. (2016)
Rosenberg et al.
(2015)
Schonert-Reichl
et al. (2015)
Shapiro et al.
(1998)
Shapiro et al.
(2010)
Taylor et al. (2015)
Unclear
Unclear
Low
Unclear
Low
Low
High
Low
Unclear
Unclear
Low
Unclear
Low
Low
Low
Low
Unclear
Unclear
Unclear
Unclear
High
Unclear
Unclear
Unclear
Low
High
Low
Low
Low
Unclear
Low
Unclear
Unclear
Unclear
Low
Low
High
Low
Low
Unclear
Unclear
Unclear
High
Low
Low
Low
Low
Low
Low
Low
Low
Low
Low
Low
High
Low
Unclear
Unclear
Low
Low
Unclear
Low
Low
Unclear
Unclear
Unclear
Low
Unclear
Low
Low
Low
Low
Unclear
Unclear
Unclear
Unclear
Unclear
Low
High
Unclear
Unclear
Unclear
Low
Unclear
Unclear
High
Low
High
Low
Unclear
High
Unclear
Low
High
High
Low
Unclear
Unclear
Unclear
Unclear
Low
Low
Unclear
Unclear
Low
Low
Low
Low
Low
Low
Low
Low
Reference
Velásquez et al.
(2015)
Wallmark et al.
(2013)
Weng et al. (2013)
Weng et al. (2015)
Random
sequence
generation
Performance bias (blinding of participants and personnel) was considered low if (1) there was an active control group and participants were not likely to
know which was the true intervention; (2) there was an inactive control group (e.g., wait-list control) but participants were not aware that the intent of the
intervention was to increase prosocial outcomes (e.g., the intervention was framed as stress reduction); or (3) there was an inactive control group and
participants were aware of the purpose of the intervention, but outcomes were measured in terms of implicit attitudes or behaviors based on deception.
Performance bias was considered high when there was an inactive control group, participants were aware of the intent of the intervention, and outcomes
were self-reported. Performance bias was considered unclear when it was unclear whether participants knew the intent of the intervention (e.g., when the
authors did not report how the study was advertised or presented to participants)
effect size for subjective outcomes across these studies was
.40 (95% CI = .28–.52, p < .001). The results were similar
across studies that used active (SMD = .43, p < .001; 95%
CI = .21–.65) and inactive control groups (SMD = .39,
p < .001; 95% CI = .24–.53). Publication bias was not
suspected based on the funnel plot and because the number
of studies needed to make the results nonsignificant was
165 (p = .55).
Mindfulness
30
Fig. 2 Risk of bias across all
studies
25
Number of Studies
5
20
5
4
3
3
4
6
7
2
1
19
15
19
25
24
10
16
18
High
Unclear
Low
17
16
5
6
0
Participant
blinding
Baseline
imbalance
Differential
attrition
Synthesis of Results for Potential Mechanisms
Fourteen studies reported results for potential mediators of
effects of meditation on prosocial outcomes. Six of these studies conducted formal mediation analyses (Ashar et al. 2016;
Hutcherson et al. 2008; Kang et al. 2014; Kok et al. 2013;
Oman et al. 2010; Shapiro et al. 1998). Formal mediation
results revealed that increased social and emotional connectedness mediated the effects of compassion meditation and
charitable donations (Ashar et al. 2016), increased positive
affect mediated the effect of LKM on explicit bias toward
marginalized groups (Hutcherson et al. 2008), decreased stress
mediated the effect of LKM on bias (Kang et al. 2014), and
greater home practice and decreased stress mediated the effect
of meditation on compassion (Oman et al. 2010). Kok et al.
(2013) tested more complex structural models and found that
loving kindness meditation led to improvements in positive
emotions, which led to improvements in social connectedness,
which led to improvements in vagal tone. Shapiro et al. (1998)
found that greater meditation compliance led to decreased
anxiety, which led to greater empathy.
Eight studies did not conduct formal mediation analyses
but explored correlations between changes in prosocial outcomes and changes in other variables that suggest potential
mechanisms of action (Jazaieri et al. 2013; Keefe 1979;
Kemeny et al. 2012; Mascaro et al. 2013; Rosenberg et al.
2015; Velásquez et al. 2015; Wallmark et al. 2013; Weng
et al. 2013). Almost all (7 out of 8) examined the relationship
between amount of home practice/meditation adherence and
prosocial outcomes: five found that greater meditation practice was correlated with greater prosocial outcomes (Jazaieri
et al. 2013; Keefe 1979; Rosenberg et al. 2015; Velásquez
et al. 2015; Wallmark et al. 2013) and two found no significant
correlation (Kemeny et al. 2012; Mascaro et al. 2013). One
study also found that increases in mindfulness and self-compassion, and decreases in stress, were significantly correlated
with increases in empathy (Wallmark et al. 2013). Two studies
used fMRI to explore correlations between prosocial outcomes and changes in neural function (Mascaro et al. 2013;
Incomplete
outcome
data
Selective
reporting
Outcome
blinding
7
1
Allocation
Random
sequence concealment
generation
Weng et al. 2013). Mascaro et al. (2013) found that improvements in empathy were correlated with increased activity in
the inferior frontal gyrus (IFG) and dorsomedial prefrontal
cortex (dmPFC). Weng et al. (2015) found that greater
prosocial behavior (charitable donations) were correlated with
changes in the inferior parietal cortex and dorsolateral prefrontal cortex.
Discussion
The results of the current systematic review support the efficacy of meditation-based interventions for increasing empathy, compassion, and prosocial behaviors. Meditation interventions showed significantly greater improvements in at least
one prosocial outcome as compared to control groups in 22
out of the 26 included RCTs (85%). Meta-analysis results
indicated that meditation training had a small-medium and
significant effect on both subjective and objective prosocial
outcomes, which was similar across studies with active and
inactive control groups if not slightly higher among those with
active controls. Many studies were low risk, with only three
studies showing a high risk of bias and there were no clear
differences in outcomes based on risk of bias. Effects for observable outcomes (e.g., real-world helping behavior, facial
expressions) were somewhat stronger and more consistent
than results for self-reported outcomes, though both showed
significant improvements in the meta-analysis.
Results of several studies suggest potential mechanisms by
which meditation can improve prosocial outcomes. Potential
emotional mechanisms include an increased sense of socialemotional connectedness with others (Ashar et al. 2016; Kok
et al. 2013), increased positive affect (Hutcherson et al. 2008;
Kok et al. 2013), decreased stress and negative affect (Kang
et al. 2014; Oman et al. 2010; Shapiro et al. 1998), and greater
trait mindfulness and self-compassion (Wallmark et al. 2013).
Some studies directly tested self-focused emotional mechanisms as mediators of meditation training on prosocial outcomes and found significant indirect effects, suggesting that
Wait-list
Flook et al. (2015) N = 68 children; 50% F, Kindness Curriculum
(medium)
59% W, Mage = 4.67
group, in person
Kang et al. (2014) N = 101 nonclinical
(low)
adults;
nonmeditators; 64%
F, 61% W,
Mage = 25.20
Kang et al. (2015) N = 54 nonclinical
(low)
adults;
nonmeditators; 67%
F, 59% W,
Mage = 24.94
Keefe (1979) (low) N = 56 social work
students
Jazaieri et al.
(2013) (low)
Hutcherson et al.
(2008) (medium)
He et al. (2015)
(medium)
Empathy
education
No intervention
Wait-list
30 min daily × 3 weeks
Discussion about 1 h once/week × 6 weeks;
loving kindness
20 min home practice
Wait-list
5 days/week
LKM; group, in person
Not reported
Session attendance: M = 4.30
sessions
(S) Kagan affective
sensitivity scale
(S) Self-Other Four
Immeasurables
scale
+ Follow-up: +
−
+
(S) Explicit bias
−
(O) Implicit attitudes +
task
+
(S) Fear of
compassion scale
Session attendance: 98% ≥7
sessions
Retention: 85%
Home practice:
M = 101.11 min/week
Session attendance: M = 4.86
sessions
Home practice:
M = 553.84 min
2 h once/week × 8 weeks;
15 min daily home practice
(O) Teacher-rated
+
social competence
(O) Sharing task
+
(S) Inclusion of
+
Other in Self Scale
(O) Giving up a seat + No meditation
group
for an injured
differences
person
(S) Explicit attitudes +
toward others
(O) Implicit attitudes +
task
Not reported
Retention: 100% Session
attendance: 92%
Home practice adherence:
85%
Session attendance: M = 6.60
sessions
Home practice: M = 3.74
practices/week
Not reported
Results
(S)
+
Compassion
composite score
(O)
−
Charitable donations
+
(S) Jefferson
empathy
questionnaire
Outcome variables
N/A
Discussion about 1 h once/week × 6 weeks;
loving kindness
20 min home practice ×
Wait-list
5 days/week
Meditation, not
specified
Intervention adherence
One 7-min practice
30 min 3×/week × 4 weeks
20–30 min 2×/week × 12 weeks
2 h once/week × 8 weeks;
20 min daily home practice
2.5 h once/week × 8 weeks; one
8-h retreat; Bregular^ home
practice
LKM; group, in person
No intervention
N = 55 Chinese college LKM; group, video
students;
nonmeditators; 84%
F, Mage = 18.5
N = 93 nonclinical
LKM; individual, audio Imagining others’
adults;
recording
physical
nonmeditators; 57%
appearance
F, 46% W,
Mage = 23.6
CM; group, in person
Wait-list
N = 100 nonclinical
adults; 72% F, 71%
W, Mage = 43.33
Wait-list
Wait-list
N = 39 nonclinical
MM; group, in person
adults; nonmediators; CM; group, in person
74% F, Mage = 25.23
Condon et al.
(2013) (medium)
Intervention dose
Oxytocin placebo 20 min daily × 4 weeks; no home Sessions completed: 74%
Strangers’ photos
practice
and brief stories
Meditation intervention Control group
Ashar et al. (2016) N = 58 nonclinical
CM; individual, audio
(medium)
adults;
recording
nonmeditators; 63%
F, 81% W,
Mage = 28.59
N = 68 PCPs in Spain; MM; group, in person
Asuero et al.
92% F, Mage = 47.00
(2014) (medium)
Sample
Summary of included studies
Reference (bias
risk)
Table 3
Mindfulness
N = 60 experienced
meditators; 54% F,
Mage = 48
N = 100 children; 46%
F, 66% English first
Schonert-Reichl
et al. (2015)
MM and prosocial;
group, in person
MM and CM retreat;
Wait-list
group and individual
Reading group
Kindness Curriculum;
group, in person
Rosenberg et al.
(2015) (low)
No intervention
Meditation, not
specified
Wait-list
Health education
Pearl and Carlozzi N = 50 nonclinical
(1994) (mediadults;
um)
nonmeditators;
Mage = 23.9
Poehlmann-Tynan N = 29 children; 49%
et al. (2016)
girls, Mage = 3.92
(medium)
CM
Passage meditation;
group, in person
N = 29 nonclinical
adults; 45% F,
Mage = 31.0
Wait-list
LKM; individual, audio Read about
mindfulness
recording
MM, individual, audio
recording
LKM; group, in
person
NA
Not reported
40–50 min once/week ×
12 weeks
3-month retreat
20–30 min 2×/week × 12 weeks
Approximately 8 weeks
Results
(S) IRI; MMRS;
compassionate
love scale;
altruism scale;
post, and 8- and
19-week f/u
(S) Affective
sensitivity scale
(O) Self/other referential processing
task
(O) Empathic
accuracy task
(S) Self-Other Four
Immeasurables
scale
+
+
−
− Follow-up: −
−
+ Follow-up: +
+
+ No meditation
group
differences
+ No meditation
group
differences
(O) Emotional
recognition task;
implicit
compassion task;
marital interaction
task; 5-month f/u
+
(S) daily social
connectedness;
1-week postintervention
Outcome variables
(O) Response to
someone getting
‘hurt’;
compassionate
stories; 3-month
f/u
Retention: 100%
(S) Emotions
Total practice: M = 41 h
composite
(O) facial coding
during film clips
of suffering
100% of lessons administered (S) IRI; Social Goals
questionnaire
Session attendance: M = 21
sessions
Not reported
2 h once/week × 8 weeks; 20 min Session attendance: M
daily home practice
attendance = 7.38 sessions
Home practice:
M = 315.9 min
2 h once/week × 8 weeks
Not reported
One 15-min practice
1 h once/week × 6 weeks; daily
home practice
42 h over 8 weeks; 25 min daily Session attendance: M = 6.67
home practice
sessions
MM, LKM, yoga;
group, in person
Intervention adherence
Intervention dose
Meditation intervention Control group
Oman et al. (2010) N = 58 healthcare
(medium)
providers; 40%
meditators; 86% F
Mascaro et al.
(2013) (low)
N = 65 university
faculty;
nonmeditators; 66%
F, 83% W,
Mage = 37.5
Logie and Frewen N = 105 undergraduate
(2015) (medistudents; mostly
um)
nonmeditators; 67%
F, 63% W,
Mage = 18.63
N = 76 female school
teachers;
nonmeditators;
Mage = 41.05
Kemeny et al.
(2012) (low)
Kok et al. (2013)
(high)
Sample
Reference (bias
risk)
Table 3 (continued)
Mindfulness
Social
responsibility
education
Wait-list
Meditation intervention Control group
Wait-list
Cognitive
reappraisal
No intervention
Cognitive
reappraisal
No intervention
MM and FI; group, in
person
CM; individual, audio
recording
CM; individual, audio
recording
−
Home practice: M = 11.8 days (O) Redistribution of +
money game
of practice, M = 351.7 min
total
Home practice: M = 11.8 days (O) Redistribution of +
money game
of practice, M = 351.7 min
total
30 min daily × 2 weeks
30 min daily × 2 weeks
+
Not reported
(S) IRI
−
+
+ Follow-up: +
+
+
Results
75 min once/week × 8 weeks;
30 min daily home practice
2 h twice/week × 12 weeks
11 sessions over 9 weeks (36 h
total); daily practice
Retention: 100%
90 min once/week × 8 weeks
(S) Empathy rating
scale
(O) Peer-reported
prosociality
Outcome variables
(S) IRI, Heartland
forgiveness scale;
2- and 12-month
f/u
Session attendance: mode = 9 (S) Santa Clara
compassion scale;
sessions
Tendency to
Home practice: M = 12.8 h
Forgive scale;
specific person
forgiveness
Session attendance: M = 17
(S) Empathy
sessions
questionnaire
(O) Peer prosociality
Retention: 97%
Intervention adherence
2.5 h once/week × 7 weeks;
weekly home practice
Intervention dose
F, female; W, white; CM, compassion meditation; MM, mindfulness meditation; LKM, loving kindness meditation; S, subjective (self-reported) outcomes; O, objective (observable) outcomes; IRI,
Interpersonal Reactivity Index; MMRS, Multidimensional Measure of Religion and Spirituality
Results are in reference to the significance of the group * time interaction, such that positive findings (+) indicate significantly greater improvements in the meditation group compared to the control group,
and negative findings (−) indicate no greater benefits of meditation compared to the control group. All outcomes were assessed immediately postintervention and outcomes that were also measured at
longer-term follow-ups are noted.
N = 46 nonclinical
adults;
nonmeditators; 86%
F, Mage = 33.8
Weng et al. (2013) N = 56 nonclinical
(low)
adults;
nonmeditators; 61%
F, Mage = 22.5
Weng et al. (2015) N = 56 nonclinical
(low)
adults;
nonmeditators; 61%
F, Mage = 22.5
Wallmark et al.
(2013) (high)
Wait-list
Yoga; group, in person
Velásquez et al.
(2015) (high)
N = 125 children in
Colombia
Wait-list
N = 78 medical
MM, LKM; group, in
students; 64% F, 79%
person
W
N = 30 undergraduate
MBSR; group, in person Wait-list
students; 87% F, 83%
W, Mage = 18.73
language,
Mage = 10.24
Sample
Taylor et al. (2015) N = 59 teachers; 90% F, MM and compassion;
(medium)
67% W, Mage = 47.00
group, in person
Shapiro et al.
(1998) (medium)
Shapiro et al.
(2010) (low)
(low)
Reference (bias
risk)
Table 3 (continued)
Mindfulness
Mindfulness
Fig. 3 Effects of meditation on objective and subjective outcomes. Note. SDM, standardized difference in means; CI, confidence interval; LL, lower
limit; UL, upper limit
meditation leads to improvements in individuals own
socioemotional functioning and, thereby, improvements in
prosocial outcomes (Ashar et al. 2016; Hutcherson et al.
2008; Kang et al. 2014; Kok et al. 2013; Shapiro et al.
1998). Consistent with the larger literature demonstrating
that meditation interventions improve self-focused emotions (Hofmann et al. 2010; Kirby 2017), these results
suggest that one way meditation practice can lead to improvements in prosocial emotions is by improving individuals’ own socioemotional well-being. These mechanisms
are also consistent with research demonstrating that
mindfulness-based interventions increase trait mindfulness
(Quaglia et al. 2016), as trait mindfulness is likely to promote real-time awareness of others’ suffering and thus
Mindfulness
Fig. 4 Funnel plots for a
objective and b subjective
outcomes
a
Objective Outcomes
b
Subjective Outcomes
greater opportunities for prosocial action (Bibeau et al.
2016). Amount of meditation practice may play a role in a
dose-response relationship, with reports of greater practice
associated with greater improvements (Jazaieri et al. 2013;
Keefe 1979; Oman et al. 2010; Rosenberg et al. 2015;
Shapiro et al. 1998; Velásquez et al. 2015; Wallmark et al.
2013). However, it is possible that some studies did not find
a relationship between home practice and outcomes and did
not report these nonsignificant findings.
This synthesis has also identified potential physiological and neural mechanisms underlying these effects. Many
meditation practices elicit physiological processes associated with the relaxation response (i.e., parasympathetic
dominance), which is the physiological counter to the
stress response (i.e., sympathetic dominance; Benson
1997). Regular elicitation of the relaxation response is associated with reduced stress and negative emotions (Esch
et al. 2003) and is thought to play a role in improving
prosocial emotions (Kirby 2017). In the current review,
meditation was indeed associated with improvements in
vagal tone (Kok et al. 2013). Meditation was also associated
with altered activation in areas of the prefrontal cortex
(Mascaro et al. 2015; Weng et al. 2013). These findings are
similar to previous studies of meditation for general health
outcomes (Marchand 2014; Pace et al. 2009) and non-RCTs
of meditation for prosocial outcomes (Klimecki et al. 2012,
2014; Leiberg et al. 2011) and further support a neural and
physiological basis for meditation’s effects on prosocial outcomes specifically.
Although not emphasized in most of the studies included in the current review, meditation-relaxation physiology
may be associated with improved prosocial outcomes
through oxytocin-mediated improvements in attachment
style. The same physiological processes that characterize
the relaxation response have been shown to occur in the
context of secure attachment and mother-child dyads,
which provide a foundation for compassion (Fricchione
2011; Hill-Soderlund et al. 2008; Mikulincer et al. 2005;
Oosterman et al. 2010). Oxytocin plays a role in both relaxation and secure attachment physiology and is also associated with greater prosocial behaviors (e.g., improved
face expression recognition, enhanced encoding of positive
social memories; Isgett et al. 2016; Mascaro et al. 2015;
Strathearn et al. 2009). If meditation stimulates oxytocin
receptors and mimics the physiology of secure attachment,
then it is reasonable and researchable to hypothesize that
meditative approaches will enhance prosocial behaviors
(Kim et al. 2014; Rilling 2009; Strathearn et al. 2009).
Only one study included in the current review directly addressed the potential role of oxytocin, by using a placebo
oxytocin control group; results indicated greater improvement in subjective but not objective prosocial outcomes
among CM participants than oxytocin placebo participants.
Recent theories highlight that the role of oxytocin in social
behavior is complex and not necessarily prosocial, depending on individual difference characteristics (e.g., gender,
psychopathology; Shamay-Tsoory and Abu-Akel 2016).
Future research should explore whether oxytocin is another
Mindfulness
physiological mechanism by which meditation leads to enhanced prosocial benefits.
Another potential mechanism of action that was not
emphasized in the current systematic review and has not
been explored in any of the studies included here involves emotional tolerance and regulation. Beyond reductions in level of emotional problems, improvements in the
way individuals withstand or respond to negative affect
might also play a role (Mascaro et al. 2015). Theoretical
conceptualizations of compassion emphasize that individuals must be able to tolerate the distress they feel in
response to another’s suffering in order to effectively enact helping behaviors (Strauss et al. 2016). Distress tolerance, an individual difference variable defined as the
ability to withstand negative affective states (Simons
and Gaher 2005), is a well-established risk factor for
emotional disorders that influences emotion regulation
strategies (i.e., low levels of distress tolerance motivate
maladaptive avoidance). Meditation interventions, particularly mindfulness meditation, have been shown to significantly increase distress tolerance and improve emotion
regulation (Chambers et al. 2009; Lotan et al. 2013), and
emotion regulation is thought to play a role in the effects
of LKM on prosocial outcomes (Mascaro et al. 2015).
Thus, meditation might also improve compassion and other prosocial outcomes by improving the way individuals
tolerate and respond to distress, in addition to decreasing
the amount of distress an individual experiences. Future
research should directly test these potential mechanisms.
The current findings are supported by the relatively
strong design and low risk of bias across many RCTs, the
homogeneity of studies included in the meta-analysis, and
evidence for lack of publication bias. Many studies used
active control groups and objective behavioral outcomes,
and meta-analysis results were similar across type of control group and outcome measure. However, samples were
all nonclinical and primarily female and White, and half did
not report the racial composition of the sample. Greater
sample diversity is needed and future studies should describe the full demographic characteristics of the sample.
Describing the details of the randomization procedure and
concealment and maintaining participant blinding (e.g.,
concealing the true intent of the study, using active matched
control groups) could also further improve the methodological rigor of future studies.
Nonetheless, this review highlights several directions for
future research. First, research on more clinically and demographically diverse samples is needed to enhance generalizability. Second, although the meta-analysis indicated
homogeneity among studies, there was variability among
the meditation interventions. Future studies may consider
using manualized protocols or conduct dismantling studies
to establish optimal intervention dose and content. In
addition, research should examine a wider range of meditation types and formats, such as movement-based meditations and individual (rather than group) in-person interventions. This research should also include comparative efficacy trials that directly compare different types of meditation and other evidence-based interventions that improve
emotional problems (i.e., traditional cognitive-behavioral
therapy). In the current review, most studies incorporated
LKM, which is a relatively newer research area as compared to mindfulness meditation, and found significant
prosocial benefits. Moreover, both of the studies that
compared LKM to mindfulness did not find significant
differences in prosociality, though Logie and Frewen
(2015) found a greater effect of LKM on reducing selfpositivity bias as compared to mindfulness meditation,
and other previous studies have found some differences in
emotional outcomes across meditation types (Zeng et al.
2015). Future studies should also incorporate longer-term
follow-ups. These findings provide further support for continued research on LKM and the need for comparative efficacy work.
It is also worth noting that some research suggests empathy and compassion may have different utility for the person
giving versus receiving help, particularly when empathizing
with another’s suffering. Empathy (affect-sharing) may increase personal distress and reduce prosocial behavior,
while compassion (affect-sharing with motivation to help)
may strengthen personal resources and promote positive
outcomes (e.g., Klimecki et al. 2014; Singer and Klimecki
2014). It is possible that these differential effects could vary
depending on the individual’s own general ability to tolerate
emotional distress. We included empathy to be comprehensive in our review of prosocial outcomes, but further research on the differential effects of empathy and compassion is warranted.
The current findings also have implications for clinical
practice and meditation teachers in nonclinical settings.
Clinicians and meditation teachers should be aware that
meditation interventions (e.g., MBSR, MBCT) could provide additional benefits beyond reduced emotional distress. Clinicians might select meditation-based protocols
for patients who are specifically interested in increasing
empathy and compassion (e.g., parents, healthcare providers), or consider incorporating meditation training into
other evidence-based interventions to maximize improvements for individuals experiencing interpersonal problems.
Results suggest that integrating meditation training into
other evidence-based interventions may be feasible, as
even two weeks of 20 minutes daily practice via mobile
phone applications have shown significant prosocial benefits. Meditation teachers in nonclinical settings should be
aware that there is a scientific evidence base to support the
broader prosocial benefits of individual meditation
Mindfulness
training, teach meditation with these benefits in mind,
and consider discussing these potential benefits with
students.
Limitations
In the current systematic review, limitations include heterogeneity in the interventions and an inability to include nonEnglish studies, which may have biased the results and
limits generalizability. Nonetheless, these results advance
the scientific understanding of meditation for health outcomes and suggest that meditation training is a promising
way to increase individual-level prosocial outcomes.
Improving these prosocial outcomes has the potential to
promote important societal changes needed today. Further
research using more diverse samples and meditation practices is warranted.
Author Contributions CML conducted the systematic review and
wrote the paper; NS served as the second reviewer for data extraction;
RS conducted the meta-analysis and edited the paper; LLP conducted the
literature search and edited the paper; ERP and GLF contributed to the
writing and editing of the paper; and GYY assisted with data extraction
and meta-analysis and contributed to the writing and editing of the
paper.Funding InformationThis study was supported by funding from
the National Center for Complementary and Integrative Health (NCCIH
2T32AT000051-6; Luberto) and National Cancer Institute (NCI
1K24CA197382; Park).
Compliance with Ethical Standards
Conflict of Interest The authors declare that they have no conflict of
interest.
Appendix
Table 4
Ovid MEDLINE search strategy
Query
#
Search strategy
1
Mind-Body Therapies/ or Mindfulness/ or meditation/ or tai
ji/ or yoga/
(Bmind body^ or MBSR or MBCT or mindfulness or meditat*
or yoga or Btai chi^ or Btai ji^ or taiji).ti,ab.
1 or 2
Empathy/ or love/ or altruism/
(empath* or compassion* or sympathy or love or kindness or
altruis*).ti,ab.
4 or 5
3 and 6
limit 7 to English language
random*.tw,hw
8 and 9
2
3
4
5
6
7
8
9
10
References
Ashar, Y. K., Andrews-Hanna, J. R., Yarkoni, T., Sills, J., Halifax, J.,
Dimidjian, S., & Wager, T. D. (2016). Effects of compassion meditation on a psychological model of charitable donation. Emotion,
16(5), 691–705. https://doi.org/10.1037/emo0000119.
Asuero, A. M., Queraltó, J. M., Pujol-Ribera, E., Berenguera, A.,
Rodriguez-Blanco, T., & Epstein, R. M. (2014). Effectiveness of a
mindfulness education program in primary health care professionals: a pragmatic controlled trial. Journal of Continuing
Education in the Health Professions, 34(1), 4–12. https://doi.org/
10.1002/chp.21211.
Benson, H. (1997). The relaxation response: therapeutic effect. Science,
278(5344), 1693–1697 Retrieved from http://www.jstor.org/
stable2894939.
Bibeau, M., Dionne, F., & Leblanc, J. (2016). Can compassion meditation
contribute to the development of psychotherapists’ empathy? A review. Mindfulness, 7(1), 255–263. https://doi.org/10.1007/s12671015-0439-y.
Bohlmeijer, E., Prenger, R., Taal, E., & Cuijpers, P. (2010). The effects of
mindfulness-based stress reduction therapy on mental health of
adults with a chronic medical disease: a meta-analysis. Journal of
Psychosomatic Research, 68(6), 539–544. https://doi.org/10.1016/j.
jpsychores.2009.10.005.
Borenstein, M., Hedges, L., Higgins, J., & Rothstein, H. (2014).
Comprehensive meta-analysis version 3.0 [computer software].
Englewood: Biostat.
Chambers, R., Gullone, E., & Allen, N. B. (2009). Mindful emotion
regulation: an integrative review. Clinical Psychology Review,
29(6), 560–572. https://doi.org/10.1016/j.cpr.2009.06.005.
Condon, P., Desbordes, G., Miller, W. B., & DeSteno, D. (2013).
Meditation increases compassionate responses to suffering.
Psychological Science, 24(10), 2125–2127. https://doi.org/10.
1177/095679761348603.
Dunn, E. W., Aknin, L. B., & Norton, M. I. (2008). Spending money on
others promotes happiness. Science, 319(5870), 1687–1688. https://
doi.org/10.1126/science.1150952.
Eberth, J., & Sedlmeier, P. (2012). The effects of mindfulness meditation:
a meta- analysis. Mindfulness, 3(3), 174–189. https://doi.org/10.
1007/s12671-012-0101-x.
Esch, T., Fricchione, G. L., & Stefano, G. B. (2003). The therapeutic use
of the relaxation response in stress-related diseases. Medical Science
Monitor, 9(2), RA23–RA34.
Faulkner, L. R., & McCurdy, R. L. (2000). Teaching medical students
social responsibility: the right thing to do. Academic Medicine,
75(4), 346–350. https://doi.org/10.1097/00001888-20000400000010.
Flook, L., Goldberg, S. B., Pinger, L., & Davidson, R. J. (2015).
Promoting prosocial behavior and self-regulatory skills in preschool
children through a mindfulness-based kindness curriculum.
Developmental Psychology, 51(1), 44. https://doi.org/10.1037/
a0038356.
Fricchione, G. L. (2011). Compassion and healing in medicine and society: on the nature and use of attachment solutions to separation
challenges. Baltimore: Johns Hopkins University Press.
Galante, J., Galante, I., Bekkers, M. J., & Gallacher, J. (2014). Effect of
kindness-based meditation on health and well-being: a systematic
review and meta-analysis. Journal of Consulting and Clinical
Psychology, 82(6), 1101–1114. https://doi.org/10.1037/a0037249.
Gilbert, P. (2010). An introduction to compassion focused therapy in
cognitive behavior therapy. International Journal of Cognitive
Therapy, 3(2), 97–112. https://doi.org/10.1521/ijct.2010.3.2.97.
Goetz, J. L., Keltner, D., & Simon-Thomas, E. (2010). Compassion: an
evolutionary analysis and empirical review. Psychological Bulletin,
136(3), 351–374. https://doi.org/10.1037/a0018807.
Mindfulness
Goldstein, J., & Kornfield, J. (2001). Seeking the heart of wisdom: the
path of insight meditation. Boston: Shambala.
Gotink, R. A., Chu, P., Busschbach, J. J., Benson, H., Fricchione, G. L., &
Hunink, M. G. (2015). Standardised mindfulness-based interventions in healthcare: an overview of systematic reviews and metaanalyses of RCTs. PLoS One, 10(4), e0124344. https://doi.org/10.
1371/journal.pone.0124344.
He, X., Shi, W., Han, X., Wang, N., Zhang, N., & Wang, X. (2015). The
interventional effects of loving-kindness meditation on positive
emotions and interpersonal interactions. Neuropsychiatric Disease
and Treatment, 11, 1273–1277. https://doi.org/10.2147/NDY.
S79607.
Higgins, J. P., & Green, S. (Eds.). (2008). Cochrane handbook for systematic reviews of interventions (version 5.0.0). Chichester: WileyBlackwell.
Hill-Soderlund, A. L., Mills-Koonce, W. R., Propper, C., Calkins, S. D.,
Granger, D. A., Moore, G. A., … & Cox, M. J. (2008).
Parasympathetic and sympathetic responses to the strange situation
in infants and mothers from avoidant and securely attached dyads.
Developmental Psychobiology, 50(4), 361–376. https://doi.org/10.
1002/dev.20302.
Hofmann, S. G., Sawyer, A. T., Witt, A. A., & Oh, D. (2010). The effect
of mindfulness-based therapy on anxiety and depression: a metaanalytic review. Journal of Consulting and Clinical Psychology,
78(2), 169–183.
Hogan, R. (1969). Development of an empathy scale. Journal of
Consulting and Clinical Psychology, 33(3), 307–316. https://doi.
org/10.1037/h0027580.
Hoge, E. A., Chen, M. M., Orr, E., Metcalf, C. A., Fischer, L. E., Pollack,
M. H., & … Simon, N. M. (2013). Loving-Kindness Meditation
practice associated with longer telomeres in women. Brain,
Behavior, and Immunity, 32, 159–163. https://doi.org/10.1016/j.
bbi.2013.04.005.
Hurst, C. E., Gibbon, H. M. F., & Nurse, A. M. (2016). Social inequality:
forms, causes, and consequences. New York: Routledge.
Hutcherson, C. A., Seppala, E. M., & Gross, J. J. (2008). Lovingkindness meditation increases social connectedness. Emotion, 8(5),
720–724. https://doi.org/10.1037/a0013237.
Ironson, G. (2007). Altruism and health in HIV. In S. G. Post (Ed.),
Altruism and health: perspectives from empirical research (pp.
70–81). New York: Oxford University Press.
Isgett, S. F., Algoe, S. B., Boulton, A. J., Way, B. M., & Fredrickson, B. L.
(2016). Common variant in OXTR predicts growth in positive emotions from loving-kindness training. Psychoneuroendocrinology, 73,
244–251. https://doi.org/10.1016/j.psyneun.2016.08.010.
Jazaieri, H., Jinpa, G. T., McGonigal, K., Rosenberg, E. L., Finkelstein, J.,
Simon-Thomas, E., … & Goldin, P. R. (2013). Enhancing compassion: a randomized controlled trial of a compassion cultivation training program. Journal of Happiness Studies, 14(4), 1113–1126.
https://doi.org/10.1007/s10902-012-9373-z.
Jüni, P., Altman, D. G., & Egger, M. (2001). Assessing the quality of
randomised controlled trials. British Medical Journal, 323(7303),
42–46. https://doi.org/10.1136/bmj.323.7303.42.
Kabat-Zinn, J. (1982). An outpatient program in behavioral medicine for
chronic pain patients based on the practice of mindfulness meditation: theoretical considerations and preliminary results. General
Hospital Psychiatry, 4(1), 33–47. https://doi.org/10.1016/0163834(82)90026-3.
Kang, Y., Gray, J. R., & Dovidio, J. F. (2014). The nondiscriminating
heart: loving kindness meditation training decreases implicit intergroup bias. Journal of Experimental Psychology: General, 143(3),
1306–13013. https://doi.org/10.1037/a0034150.
Kang, Y., Gray, J. R., & Dovidio, J. F. (2015). The head and the heart:
effects of understanding and experiencing loving kindness on attitudes toward the self and others. Mindfulness, 6(5), 1063–1070.
https://doi.org/10.1007/s12671-014-0355-6.
Keefe, T. (1979). The development of empathic skill: a study. Journal of
Education for Social Work, 15(2), 30–37 Retrieved from http://
www.jstor.org/stable/23038875.
Kemeny, M. E., Foltz, C., Cavanagh, J. F., Cullen, M., Giese-Davis, J.,
Jennings, P., & … Ekman, P. (2012). Contemplative/emotion training
reduces negative emotional behavior and promotes prosocial responses. Emotion, 12(2), 338–350. https://doi.org/10.1037/a0026118.
Khoury, B., Lecomte, T., Fortin, G., Masse, M., Therien, P., Bouchard, V.,
& … Hofmann, S. G. (2013). Mindfulness-based therapy: a comprehensive meta-analysis. Clinical Psychology Review, 33(6), 763–
771. https://doi.org/10.1016/j.cpr.2013.05.005.
Kim, S., Fonagy, P., Koos, O., Dorsett, K., & Strathearn, L. (2014).
Maternal oxytocin response predicts mother-to-infant gaze. Brain
Research, 1580, 133–142. https://doi.org/10.1016/j.brainres.2013.
10.050.
Kirby, J. N. (2017). Compassion interventions: the programmes, the evidence, and implications for research and practice. Psychology and
Psychotherapy: Theory, Research and Practice, 90(3), 432–455.
Kirkwood, G., Rampes, H., Tuffrey, V., Richardson, J., & Pilkington, K.
(2005). Yoga for anxiety: a systematic review of the research evidence. British Journal of Sports Medicine, 39(12), 884–891. https://
doi.org/10.1136/bjsm.2005.018069.
Klimecki, O. M., Leiberg, S., Lamm, C., & Singer, T. (2012). Functional
neural plasticity and associated changes in positive affect after compassion training. Cerebral Cortex (New York, N.Y.:1991), 23(7),
1552–1561. https://doi.org/10.1093/cercor/bhs142.
Klimecki, O. M., Leiberg, S., Ricard, M., & Singer, T. (2014). Differential
pattern of functional brain plasticity after compassion and empathy
training. Social Cognitive and Affective Neuroscience, 9(6), 873–
879. https://doi.org/10.1093/scan/nst060.
Kok, B. E., Coffey, K. A., Cohn, M. A., Catalino, L. I., Vacharkulksemsuk,
T., Algoe, S. B., & … Fredrickson, B. L. (2013). How positive emotions build physical health: perceived positive social connections account for the upward spiral between positive emotions and vagal tone.
Psychological Science, 24(7), 1123–1132. https://doi.org/10.1177/
0956797612470827.
Lazarus, R. S. (1991). Emotion and adaptation. Oxford: Oxford
University Press.
Leiberg, S., Klimecki, O., & Singer, T. (2011). Short-term compassion
training increases prosocial behavior in a newly developed prosocial
game. PLoS One, 6(3), e17798. https://doi.org/10.1371/journal.
prone.0017798.
Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C.,
Ioannidis, J. P., & … Moher, D. (2009). The PRISMA statement
for reporting systematic reviews and meta-analyses of studies that
evaluate health care interventions: explanation and elaboration.
Annals of Internal Medicine, 151(4), W65–W94.
Lim, D., & DeSteno, D. (2016). Suffering and compassion: the links
among adverse life experiences, empathy, compassion, and
prosocial behavior. Emotion, 16(2), 175–182. https://doi.org/10.
1037/emo0000144.
Logie, K., & Frewen, P. (2015). Self/other referential processing following mindfulness and loving-kindness meditation. Mindfulness, 6(4),
778–787. https://doi.org/10.1007/s12671-014-0317-z.
Lotan, G., Tanay, G., & Bernstein, A. (2013). Mindfulness and distress
tolerance: relations in a mindfulness preventive intervention.
International Journal of Cognitive Therapy, 6(4), 371–385. https://
doi.org/10.1521/ijct.2013.6.4.371.
Luberto, C. M., White, C., Sears, R. W., & Cotton, S. (2013). Integrative
medicine for treating depression: an update on the latest evidence.
Current Psychiatry Reports, 15(9), 1–9. https://doi.org/10.1007/
s11920-013-2.
Marchand, W. R. (2014). Neural mechanisms of mindfulness and meditation: evidence from neuroimaging studies. World Journal of
Radiology, 6(7), 471–479. https://doi.org/10.4329/wjr.v6.i7.471.
Mindfulness
Mascaro, J. S., Rilling, J. K., Negi, L. T., & Raison, C. L. (2013).
Compassion meditation enhances empathic accuracy and related
neural activity. Social Cognitive and Affective Neuroscience, 8(1),
48–55. https://doi.org/10.1093/scan/nss095.
Mascaro, J. S., Darcher, A., Negi, L. T., & Raison, C. L. (2015). The
neural mediators of kindness-based meditation: a theoretical model.
Frontiers in Psychology, 6, 109. https://doi.org/10.3389/fpsyg.2015.
00109.
Mikulincer, M., Shaver, P. R., Gillath, O., & Nitzberg, R. A. (2005).
Attachment, caregiving, and altruism: boosting attachment security
increases compassion and helping. Journal of Personality and
Social Psychology, 89(5), 817–839.
Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009). Preferred
reporting items for systematic reviews and meta-analyses: the
PRISMA statement. Annals of Internal Medicine, 151(4), 264–
269. https://doi.org/10.1037/0022-3514.89.5.817.
Nelson, S. K., Layous, K., Cole, S. W., & Lyubomirsky, S. (2016). Do unto
others or treat yourself? The effects of prosocial and self-focused
behavior on psychological flourishing. Emotion (Washington, D.C.),
16(6), 850–861. https://doi.org/10.1037/emo0000178.
Nydahl, L. O. (2008). The way things are: a living approach to Buddhism
for today’s world. Alresford: John Hunt Publishing.
Oman, D., Thoresen, C. E., & Hedberg, J. (2010). Does passage meditation foster compassionate love among health professionals?: a
randomised trial. Mental Health, Religion and Culture, 13(2),
129–154. https://doi.org/10.1080/13674670903261954.
Oosterman, M., De Schipper, J. C., Fisher, P., Dozier, M., & Schuengel, C.
(2010). Autonomic reactivity in relation to attachment and early adversity among foster children. Development and Psychopathology,
22(1), 109–118. https://doi.org/10.1017/S0954579409990290.
Pace, T. W., Negi, L. T., Adame, D. D., Cole, S. P., Sivilli, T. I., Brown, T.
D., & … Raison, C. L. (2009). Effect of compassion meditation on
neuroendocrine, innate immune and behavioral responses to psychosocial stress. Psychoneuroendocrinology, 34(1), 87–98. https://
doi.org/10.1016/j.psyneun.2008.08.011.
Pascoe, E. A., & Richman, L. S. (2009). Perceived discrimination and
health: a meta-analytic review. Psychological Bulletin, 135(4), 531–
554. https://doi.org/10.1037/a0016095.
Pearl, J. H., & Carlozzi, A. F. (1994). Effect of meditation on empathy
and anxiety. Perceptual and Motor Skills, 78(1), 297–298. https://
doi.org/10.2466/pms.1994.78.1.297.
Penner, L. A., Dovidio, J. F., Piliavin, J. A., & Schroeder, D. A. (2005).
Prosocial behavior: multilevel perspectives. Annual Psychology
Review, 56, 365–392. https://doi.org/10.1146/annurev.psych.56.
091103.070141.
Piet, J., Würtzen, H., & Zachariae, R. (2012). The effect of mindfulnessbased therapy on symptoms of anxiety and depression in adult cancer patients and survivors: a systematic review and meta-analysis.
Journal of Consulting and Clinical Psychology, 80(6), 1007–1020.
https://doi.org/10.1037/a0028329.
Poehlmann-Tynan, J., Vigna, A. B., Weymouth, L. A., Gerstein, E. D.,
Burnson, C., Zabransky, M., & … Zahn-Waxler, C. (2016). A pilot
study of contemplative practices with economically disadvantaged
preschoolers: children’s empathic and self-regulatory behaviors.
Mindfulness, 7(1), 46–58. https://doi.org/10.1007/s1261-015-0426-3.
Quaglia, J. T., Braun, S. E., Freeman, S. P., McDaniel, M. A., & Brown,
K. W. (2016). Meta-analytic evidence for effects of mindfulness
training on dimensions of self-reported dispositional mindfulness.
Psychological Assessment, 28(7), 803–818. https://doi.org/10.1037/
pas0000268.
Rilling, J. K. (2009). A potential role for oxytocin in the intergenerational
transmission of secure attachment. Neuropsychopharmacology,
34(13), 2621–2622. https://doi.org/10.1038/npp.2009.136.
Rosenberg, E. L., Zanesco, A. P., King, B. G., Aichele, S. R., Jacobs, T.
L., Bridwell, D. A., & … Saron, C. D. (2015). Intensive meditation
training influences emotional responses to suffering. Emotion
(Washington, D.C.), 15(6), 775–790. https://doi.org/10.1037/
emo0000080.
Royle, P., & Waugh, N. (2005). A simplified search strategy for identifying randomised controlled trials for systematic reviews of health
care interventions: a comparison with more exhaustive strategies.
BMC Medical Research Methodology, 5, 23. https://doi.org/10.
1186/141-288-5-23.
Schonert-Reichl, K. A., Oberle, E., Lawlor, M. S., Abbott, D., Thomson,
K., Oberlander, T. F., & Diamond, A. (2015). Enhancing cognitive
and social–emotional development through a simple-to-administer
mindfulness-based school program for elementary school children: a
randomized controlled trial. Developmental Psychology, 51(1), 52–
66. https://doi.org/10.1037/a0038454.
Sears, R. W., Tirch, D. D., & Denton, R. B. (2011). Mindfulness in
clinical practice. New York: Professional Resource Exchange.
Segal, Z., Williams, J., & Teasdale, J. (2012). Mindfulness-based cognitive therapy for depression (2nd ed.). New York: Guilford.
Shamay-Tsoory, S. G., & Abu-Akel, A. (2016). The social salience hypothesis of oxytocin. Biological Psychiatry, 79(3), 194–202. https://
doi.org/10.1016/j.biopsych.2015.07.020.
Shapiro, S. L., Schwartz, G. E., & Bonner, G. (1998). Effects of
mindfulness-based stress reduction on medical and premedical students. Journal of Behavioral Medicine, 21(6), 581–599. https://doi.
org/10.1023/A:1018700892.
Shapiro, S. L., Brown, K. W., Thoresen, C., & Plante, T. G. (2010). The
moderation of mindfulness-based stress reduction effects by trait
mindfulness results from a randomized controlled trial. Journal of
Clinical Psychology, 67(3), 267–277. https://doi.org/10.1002/jclp.
20761.
Shonin, E., Van Gordon, W., Compare, A., Zangeneh, M., & Griffiths, M.
D. (2015). Buddhist-derived loving-kindness and compassion meditation for the treatment of psychopathology: a systematic review.
Mindfulness, 6(5), 1161–1180. https://doi.org/10.1007/s12671-0140368-1.
Simons, J. S., & Gaher, R. M. (2005). The distress tolerance scale: development and validation of a self-report measure. Motivation and
Emotion, 29(2), 83–102. https://doi.org/10.1007/s11031-005-7955-3.
Singer, T., & Klimecki, O. M. (2014). Empathy and compassion. Current
Biology, 24(18), R875–R878. https://doi.org/10.1016/j.cub.2014.
05.054.
Strathearn, L., Fonagy, P., Amico, J., & Montague, P. R. (2009). Adult
attachment predicts maternal brain and oxytocin response to infant
cues. Neuropsychopharmacology, 34(13), 2655–2666. https://doi.
org/10.1038/npp.2009.103.
Strauss, C., Taylor, B. L., Gu, J., Kuyken, W., Baer, R., Jones, F., &
Cavanagh, K. (2016). What is compassion and how can we measure
it? A review of definitions and measures. Clinical Psychology
Review, 47, 15–27. https://doi.org/10.1016/j.cpr.2016.05.004.
Taylor, C., Harrison, J., Haimovitz, K., Oberle, E., Thomson, K.,
Schonert-Reichl, K., & … Roeser, R. W. (2015). Examining ways
that a mindfulness-based intervention reduces stress in public school
teachers: a mixed-methods study. Mindfulness, 7(1), 115–129.
https://doi.org/10.1007/s12671-015-0425-4.
Uebelacker, L. A., Epstein-Lubow, G., Gaudiano, B. A., Tremont, G.,
Battle, C. L., & Miller, I. W. (2010). Hatha yoga for depression:
critical review of the evidence for efficacy, plausible mechanisms
of action, and directions for future research. Journal of Psychiatric
Practice, 16(1), 22–33. https://doi.org/10.1097/01.pra.0000367775.
88388.96.
Velásquez, A. M., López, M. A., Quiñonez, N., & Paba, D. P. (2015).
Yoga for the prevention of depression, anxiety, and aggression and
the promotion of socio-emotional competencies in school-aged children. Educational Research and Evaluation, 21(5–6), 407–421.
https://doi.org/10.1080/13803611.2015.1111804.
Wallace, B. A. (1999). Boundless heart: cultivation of the four
immeasurables. Boston: Snow Lion Publications.
Mindfulness
Wallmark, E., Safarzadeh, K., Daukantait, D., & Maddux, R. E. (2013).
Promoting altruism through meditation: an 8-week randomized controlled pilot study. Mindfulness, 4(3), 223–234. https://doi.org/10.
1007/s12671-012-0115-4.
Walsh, R., & Shapiro, S. L. (2006). The meeting of meditative disciplines
and Western psychology: a mutually enriching dialogue. American
Psychologist, 61(3), 227–239. https://doi.org/10.1037/0003-066X.
61.3.227.
Weinstein, N., & Ryan, R. M. (2010). When helping helps: autonomous motivation for prosocial behavior and its influence on
well-being for the helper and recipient. Journal of Personality
and Social Psychology, 98(2), 222–244. https://doi.org/10.
1037/a0016984.
Weng, H. Y., Fox, A. S., Shackman, A. J., Stodola, D. E., Caldwell, J.
Z., Olson, M. C., & … Davidson, R. J. (2013). Compassion
training alters altruism and neural responses to suffering.
Psychological Science, 24(7), 1171–1180. https://doi.org/10.
1177/0956797612469537.
Weng, H. Y., Fox, A. S., Hessenthaler, H. C., Stodola, D. E., & Davidson,
R. J. (2015). The role of compassion in altruistic helping and punishment behavior. PLoS One, 10(12), e0143794. https://doi.org/10.
1371/journal.pone.0143794.
Zeng, X., Chiu, C. P., Wang, R., Oei, T. P., & Leung, F. Y. (2015). The
effect of loving- kindness meditation on positive emotions: a metaanalytic review. Frontiers in Psychology, 6, 1693. https://doi.org/10.
3389/fpsyq.2015.01693.
Документ
Категория
Без категории
Просмотров
21
Размер файла
1 356 Кб
Теги
017, s12671, 0841
1/--страниц
Пожаловаться на содержимое документа